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Consent in Social Care – Perspectives Around the Well-being Act (2014)
In March I took a look at how the issue of consent is handled within the Social Services and Well-being (Wales) Act, 2014. I argued that the bar was being raised beyond a standard definition of informed consent, such as that widely referred to benchmark “for consent to be valid, it must be voluntary and informed, and the person consenting must have the capacity to make the decision” (NHS Choices). It is a topic I would like to return to today as I feel that it is at the heart of the legislative intent.
Raising the standard
Whilst the principles of informed consent certainly apply, the Act is much more ambitious than fulfilling a minimum standard. How so? To answer that question I went back to the legislation and had a closer look. Reading legislation is never easy, as it is full of technical and legalistic jargon, but I wanted to take a much closer look at how consent features within the Act. This is where I had a bit of a shock.
Within the Act, the issue of consent is closely related to the idea of 'permission.' But often this is not about an individual giving consent for their support plan or an aspect of their care or support, it is to do with the myriad cast of characters and powers encompassed by the Act. This includes the Secretary of State, ministers in Westminster and Cardiff, local authorities, health boards, carers, those with parental responsibility and is often related to specific functions within the Act such as assessment or payments. So in many ways the way in which consent is supported within the Act is less to do with these technical aspects of consent, and more to do with the way in which the whole legislation is conceptualised and set out.
Authoritarian or enabling?
There may even be a contradiction here. The determinants of well-being as set out in the Act, reach deep into the lives of those receiving care and support, and cover every aspect of their experience such as relationships, work and leisure activity, and making a contribution to society. But what could be controlling, draconian and authoritarian is transformed by the values and principles embodied by the legislation.
So what are these principles? According to the Care Council for Wales the fundamental principles of the Act are:
- Voice and control – putting the individual and their needs, at the centre of their care, and giving them a voice in, and control over reaching the outcomes that help them achieve well-being.
- Prevention and early intervention – increasing preventative services within the community to minimise the escalation of critical need.
- Well-being – supporting people to achieve their own well-being and measuring the success of care and support.
- Co-production – encouraging individuals to become more involved in the design and delivery of services.
There is a clear recognition in these principles that service users need to be central to support and care. These enabling principles are clearly central to the legislative intent. So I was determined to find evidence within the legislation which supported these claims. If not in my 'consent' search, then where would I find the hard evidence in black and white?
When I returned to the Act I didn’t have to look for long. In the very brief preface to the Act it says the purpose of the Act is to improve "the well-being outcomes for people...(and) co-operation and partnership by public authorities with a view to improving the well-being of people." This sets out the stall for the whole Act and places the individual firmly at the centre and whilst not referring directly to consent, certainly strengthens the autonomous choices available to service users.
To conclude, the principle of consent in the Act is both explicit and more deeply embedded specifically within the determinants of well-being and more generally within the values and principles underpinning the Act.
For learning materials related to the Act please go to: http://www.ccwales.org.uk/getting-in-on-the-act-hub/
Nic Bowler – QCS Expert Welsh Care Contributor